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How to speak the same language: Mr. Ted, A case study on “translating” end-of-life conversations

Dr. Monica Williams-Murphy is a Board Certified Emergency Medicine Physician, who practices in one of the largest emergency departments in the United States at Huntsville Hospital. Through her writing and speaking, she is devoted to transforming the end of life into a time of peace, closure and healing. Media Page

We doctors are taught a foreign language in medical school, but we often forget this fact when talking to our patients. Now, unless your patient is a rocket-scientist (and some of mine are, I practice in a NASA-town), then most of your patients don’t “speak” statistics. Most of your patients didn’t take advanced anatomy classes… in other words, unless you translate what you are thinking, they may not have a clue what you are trying to say. But, the onus is on you, the healthcare provider. If someone cannot understand what you are saying, then it is your fault. The challenge is how to translate, how to speak the same language- which is usually the language you learned before medical school (or nursing school, or physician-assistant school, etc.)

In this regard, I am lucky because I was born into a working class family. My mother finished high school but my father did not. The gift in this is that I speak “plain English” and a little “plain Spanish” on occasion. Too many doctors were born into highly educated families and therefore, believe that everyone thinks or speaks at their level…XX (hear the wrong answer buzzer!)

I once had a patient remind me of the importance of “translating” our knowledge back into “plain language.” I will never forget Mr. Ted and neither will my staff…

Mr. Ted was “sent” to the ER by his son who lived in another state. Mr. Ted had advanced metastatic cancer and had recently been placed on blood thinners to treat blood clots which had developed in his lungs- a condition likely caused by the cancer itself.

According to the nice neighbor-lady who came in with Mr. Ted, he had stopped taking the blood thinners, because as she put it, “He said he was ready to “go”… that he is tired.” She also explained that when Mr. Ted’s son called this neighbor-lady to have her check on his dad, that he was very upset that “Daddy had stopped his blood thinners.” Apparently, he demanded that nice neighbor-lady bring him into the ER for treatment.

Now, I am never one to let bossy, demanding family members get in the way of the desires of my patients. So, I had it in my mind to call this son and “tell him like it is”…. after I figured out exactly “what it is” that my patient, himself wanted.

This proved to be the challenge:

After some social niceties with nice neighbor-lady in the room, I turned my full attention to Mr. Ted himself. I had wondered why he had not spoken up during the information that had already been shared, so I picked up his hand and bent over the rails of the stretcher.

“Mr. Ted,” I said, “I understand that you have metastatic cancer and blood clots in your lungs. Is that right?”

He just looked at me, rather blankly and blinked his eyes a few times as if I had blown some dust into his face.

Nice neighbor-lady spoke up and said, “Mr. Ted doesn’t have good understanding and he doesn’t hear well, so you will have to speak loudly and simply to him.”

“Ok. I can do that,” I thought to myself….”let’s try this….”

Using my strongest, deepest voice, I said, “Mr. Ted, I hear you got cancer that’s spread and that you have some clots in your lungs that give you trouble breathing is that right?”

So, I took a deep breath and basically yelled into his ear: “Mr. Ted, I hear you eat up with cancer and you got some blood stuck in your lungs makin’ it hard to breathe! Is that right?”

He shook his head and said, “Right.”

Just then a war-hardened ER nurse jerked open the curtain and with a scowl of disapproval on her face whispered, “Murphy! What in the world are you yelling at this man?”

I smiled and whispered back to her, “Something he understands. There is going to be more of this, so please pull the curtain.”

Her face softened into a smile in response and then she closed the curtain with care.

Next came the hard part. I translated it before I yelled it out this time:

“Mr. Ted, whatcha want us to do? You wanna be on that medicine to melt those clots in your lungs or not? Making those clots go away won’t change your cancer!”

In response, he simply asked “Doc, am I dying?”

I paused, took a deep breath and very boldly yelled out, “Everybody in here is dying, but looks like you’re going first! We don’t have any medicine keep you from dying at this point, it’s just a matter of time!”

He looked me in the eyes and said, “I know that. That’s why I don’t care ’bout that blood stuck in my chest. Alls I want is not to hurt anymore.”

I noticed that there were numerous staff feet visible beneath Mr. Ted’s room curtain. They didn’t need to stand close to hear what I was yelling, so I knew they were standing close to hear what Mr. Ted had to say in response.

Mr. Ted told me exactly what he wanted and didn’t want, in his own words.

Ultimately, I was able to translate this to his son in terms that he also understood. And, finally, we were all on the same page, because we were all speaking the same “language.” Mr. Ted went back home, without blood thinners, on hospice care- as he desired.

Translating hard conversations is never easy or comfortable, but is always worth it. Just ask Mr. Ted.

-Monica Williams-Murphy, MD

As always, names and elements of the story are changed to protect patient privacy. Date of publication has no relevance to date of the actual patient encounter.

"It's OK to Die" is a ground-breaking book filled with graphic stories straight out of the Emergency Room illustrating how most Americans are completely unprepared for death and dying. In response, the authors have created a unique and comprehensive guide urging EVERYONE to prepare in advance, to assure their own peace and to prevent the suffering of their loved ones. Learn More..

6 thoughts on “How to speak the same language: Mr. Ted, A case study on “translating” end-of-life conversations”

I just love this vignette of Mr. Ted and you…and all the staff wondering what will happen next. It’s gorgeous, perhaps especially because it’s just plain English – the kind that most of us speak and understand. Just right to translate your MD-speak back into our just-plain. Maybe Mr. Ted wouldn’t have said a single word if you hadn’t translated! Maybe he wouldn’t have understood anything you said, so what good would that have been?! Clear case of helping by starting where the patient is. !!! If only all of us could do this, health care would be vastly improved…and it wouldn’t cost a dime! Love it! Top quality! Excellent lesson also in humanity and bioethics! Thanks for writing it!! More, please!

Many thanks for making – and illustrating – a point so eloquently and charmingy. It brings home what’s often an abstract concept: going to where the patient is.
Reminds me of a narrative I read by a PCP/Family doc practicing in the Apalachans: ‘When I asked about diabetes, I got blank looks. When I asked about their ‘sugars’ they got it. I learned to say ‘you look lower than a snake’s belly’ when I wanted to get their attention.”

As a non-healthcare professional keenly interested i health communications, I’ve gathered (even single syllable) words that can confuse out of context: treat, void, mass, stool… to name but a few.

“End of Life Conversations – A case study| Ok to Die | It’s OK to Die” ended up being a delightful post, can not help but wait to look at far more of your articles. Time to spend a little time on the web lmao. Regards -Howard

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